UMB Application

This form must be completed, notarized, and submitted with proof of age and membership fee ($75.00 prior to 1/1/19 or $100.00 after 1/1/19) to:

UMB c/o Tim O'Neal

46 Mill Creek Road

Lander WY 82520

Membership and Liability Release

NAME:______________________________________________________

Adress-_____________________________________________________

City-_______________________________________ST-___ZIP-_______

Email-___________________________________Phone_____________

AGE as of 1/1/2019-______Date of Birth-__________________________

Parents/Guardians Consent and General Release

I/We certify that the age and date of birth of the above child is correct, and do hereby consent to said child joining the ULTIMATE MINIATURE BULLRIDING (UMB). In consideration of allowing above child to join the UMB, I/We agree that I/We will in no manner hold the UMB, or its agents, officers, directors, producers, or any individual connected to the UMB event, liable for any accident, injury, property damage, or death to contestant, property, assistants, or stock. And further, I/We do hereby RELEASE and agree to HOLD HARMLESS, the UMB, it's agents, officers, directors, producers, and any individual connected to the UMB, from any and all liabilty for damage, injury, or death as a result of, or related to the participation of any child in any capacity in UMB events. I/We are fully aware of the dangers involved in UMB participation, and have read this release and fully understand its terms. I/We are also aware that this membership may be denied or revoked at the descretion of the UMB based on actions by My/Our selves or our child deemed detrimental to UMB or affiliated associations. In the case of revocation membership fee is non-refundable.